Provider Demographics
NPI:1346616281
Name:KIRK, JEAN KAY (APRN CNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:KAY
Last Name:KIRK
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:KAY
Other - Last Name:ZINKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1406 6TH AVENUE NORTH
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1900
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7115
Practice Address - Street 1:1900 CENTRACARE CIRCLE #2475
Practice Address - Street 2:CENTRACARE HEALTH PLAZA
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4977
Practice Address - Fax:320-229-5109
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1906705163W00000X
MNCNP4000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse